Cervical Neoplasia and Repeated Positivity of Human Papillomavirus Infection In Human Immunodeficiency Virus-seropositive and -seronegative Women

Abstract

Increased risk for cervical intraepithelial neoplasia (CIN) in human immunodeficiency virus (HIV)-infected women may be explained by repeated positivity of human papillomavirus (HPV) infection facilitated by HIV infection and related immunosuppression. As part of a longitudinal study with semiannual examinations, 268 women in Baltimore, Maryland (of whom 184 were HIV+), provided 1,426 cervicovaginal lavage specimens tested for HPV DNA by a polymerase chain reaction-based assay between 1992 and 1998. HPV positivity and time to HPV clearance according to HIV serostatus and CD4+ cell count were compared using models for correlated binary data and survival analysis. Of the 187 participants who had at least one positive measurement, the probability of subsequent HPV positivity among HIV- women and HIV+ women with CD4+ > or =200 and <200 cells/microl was 47.5%, 78.7%, and 92.9% (p < 0.001). Within-women HPV results were correlated (i.e., clustered) in each group (p < 0.01). Compared with HIV-participants, the relative incidence of HPV clearance was 0.29 and 0.10 among HIV+ women with CD4+ > or =200 and <200 cells/microl (p < 0.001). At the end of follow-up, 11 women had biopsy-confirmed CIN. The association of HIV and CIN (p = 0.014) was fully explained by repeated HPV positivity induced by HIV infection (p = 0.648). Reversal of immunosuppression following potent antiretroviral therapy must be expected to have a dramatic impact on HIV-related CIN.

Risk of cancer in persons with AIDS in Italy, 1985–1998

“…A similar time pattern was found for anal cancer, whose overall SIR (34) was well comparable to the one seen for ICC. Three additional cases of cancer of the vulva, penis, and uterus (not otherwise specified) further support the possibility that HIV-induced immune impairment facilitates the persistence of HPV infection (Palefsky et al, 1999;Ahdieh et al, 2000): progression into pre-malignant (Sun et al, 1997) and, ultimately, in the lack of early detection, invasive cancer. As suggested also by studies where preinvasive lesions of the cervix and anogenital tract were included (Frisch et al, 2000), the control of HPV infections seems to be impaired in HIV-positive women and men years before a diagnosis of AIDS.…”

Six‐month natural history of oral versus cervical human papillomavirus infection

“…8,9 This data is also consistent with prior longitudinal studies that attributed the elevated prevalence of cervical HPV infection among HIV-infected women to both an increased risk of incident and persistent infection as severity of immunosuppression increased. 10,[18][19][20][21][22][23][24][25] Strickler and colleagues recently reported a strong interaction between serum HIV viral load and CD4 cell count on cervical HPV natural history in the WIHS study cohort. 24 Because of sample size constraints, a larger study will be needed to evaluate the interaction of HIV viral load and CD4 cell count on oral HPV natural history.…”

Cancer incidence in women with or at risk for HIV

“…HPV persistence in HIVinfected women, resulting in an increase in cervical intraepithelial neoplasia (CIN), the precursor to ICC, has also been reported. 28,29 Immunosuppression also seems to increase the incidence of CIN in HIV-infected women. However, in our study, CD4ϩ cell counts were above 200/mm 3 in all our cervical cancer patients, similar to findings in other reports.…”